What Is Undifferentiated Schizophrenia?

Undifferentiated schizophrenia is an outdated term for a type of schizophrenia in which a person meets the criteria for the disorder but cannot be classified into just one of its four subtypes. While undifferentiated schizophrenia is no longer listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), some healthcare providers still use the term.

Under the older definition, people with undifferentiated schizophrenia exhibit symptoms of more than one type of schizophrenia. These may include delusions, paranoia, hallucinations, and other symptoms that interfere with a person's sense of reality.

This article explains what undifferentiated schizophrenia is and why the term is no longer widely used in the medical community. It also describes the symptoms of undifferentiated schizophrenia as well as the causes, diagnosis, and treatment of schizophrenia in the current context.

Definition of Undifferentiated Schizophrenia

Schizophrenia is a mental health condition that interferes with a person's perception of reality. In earlier editions of the DSM, schizophrenia was divided into five subtypes. undifferentiated schizophrenia essentially served as a catch-all diagnosis when someone's symptoms did not fit neatly into any other category.

• Paranoid schizophrenia: "Positive symptoms," like delusions and hallucinations, are dominant
• Disorganized schizophrenia (hebephrenic schizophrenia): Cognitive and "negative symptoms," such as disorganized thought and disorganized speech, are dominant
• Residual schizophrenia: Criteria for schizophrenia are met, but symptoms are milder
• Catatonic schizophrenia: Criteria for schizophrenia are met and there are additional symptoms of catatonia (excessive or decreased movement)
• Undifferentiated schizophrenia: Symptoms of more than one subtype of schizophrenia are present, but a person does not exhibit enough of one to be classified as that subtype

Why the Term Is No Longer Used

The most recent edition of the DSM (DSM-5) no longer includes any of the five subtypes of schizophrenia. According to the American Psychiatric Association, the classifications have not proven to be reliable in diagnosing schizophrenia and do not reflect the broad diversity of symptoms that can occur in people with schizophrenia.

And just as undifferentiated schizophrenia was an "other" category of schizophrenia that could potentially lump a variety of very different cases under one diagnosis, residual schizophrenia enabled a diagnosis even if the symptoms weren't all that striking. Both subtypes were problematic as they could lead to misdiagnoses and inappropriate treatment.

With no longer formal clinical diagnoses, the five subtypes are still used by some clinicians as a way to discuss the nature of a person's condition and explain why certain treatments are needed (say, for paranoia, catatonia, or hallucinations).

Symptoms and Diagnostic Criteria

How symptoms would lead to a diagnosis of schizophrenia is very different today than in previous editions of the DSM.

Today, schizophrenia is understood to take many different forms and can be experienced in different ways by different people. Moreover, the symptoms may not occur all at the same time and can change over time. The formal name was changed to schizophrenia spectrum disorder in 2013 to reflect this.

With this in mind, the symptoms of schizophrenia are broken down into five broad categories in the DSM-5:

• Delusions: These are false beliefs that are strongly held despite evidence that they are not true.
• Hallucinations: These are the experience of hearing, seeing, smelling, tasting, or feeling things that are not there.
• Disorganized speech: This is speech that is jumbled, incoherent, and/or illogical.
• Grossly disorganized or catatonic behavior: These are behaviors characterized by stupor or unresponsiveness, rigidity or unpredictable movements, or mania.
• Negative symptoms: This is the lack of expected behaviors such as "flat" speech and facial expression, reduced desire for social contact, lack of motivation, and the inability to feel pleasure

Then vs. Now

To be diagnosed with schizophrenia under the criteria set out in previous editions of the DSM, one of the following had to apply:

• At least two of the above-mentioned symptoms were present
• Only "bizarre" delusions were present
• Only hallucinations including a voice(s) with running commentary were present

Based on which combination of symptoms a person had, or which symptoms predominated, a person could be classified as having either paranoid, disorganized, or catatonic schizophrenia.

If symptoms were not profound or specific enough to meet the criteria for these subtypes, a diagnosis of undifferentiated schizophrenia would be made.

If a person had a schizophrenic episode but no longer had delusions, hallucinations, or disorganized speech, a diagnosis of residual schizophrenia would be made.

Schizophrenia Diagnosis Process

Although the criteria for the diagnosis of schizophrenia have changed, the process by which symptoms are identified and classified remains the same.

Identifying and classifying the symptoms requires the expertise of a psychiatrist or other certified mental health professional. They are trained to classify and characterize symptoms under a strict set of criteria based on observation and interviews.

Other tests may be ordered to rule out somatic (physical) causes of your symptoms.

Examination

During an examination, a healthcare provider will:

• Ask about symptoms
• Review the person's medical history
• Review the person's family medical history
• Perform a physical examination
• Rule out other conditions besides schizophrenia

Lab Tests

There is no lab test that confirms or rules out a diagnosis of schizophrenia. Blood, urine, or other lab tests may be ordered to identify other possible conditions that may explain the person's symptoms.

Depending on the situation, a healthcare provider may order a blood or urine test to identify the presence of medications or illicit drugs that could be causing the symptoms.

Imaging Tests

A magnetic resonance imaging (MRI) or a computerized tomography (CT) may be ordered if there is concern that there could be an underlying physical cause for the symptoms, such as a brain tumor.

What Causes Schizophrenia?

The specific cause of schizophrenia, and by extension undifferentiated schizophrenia, is not known, but there are several risk factors.

Age

While undifferentiated schizophrenia can occur at any age, symptoms usually begin during the age range of the late teens to the early thirties.

Genetics

Undifferentiated schizophrenia appears to run in families. Having schizophrenia in the family does not mean a person will develop schizophrenia, but it increases the risk.

Compared to the 1% prevalence of schizophrenia in the general population, there is a 10% prevalence among people who have a biological parent or sibling with schizophrenia. The highest risk is associated with identical twins.

Having a second-degree relative such as an aunt, uncle, grandparent, or cousin who has schizophrenia also increases a person's chances of developing the condition.

It is likely that multiple genes are involved in the development of schizophrenia.

Environment

It is believed that the interaction between genetics and environmental factors influences the development of undifferentiated schizophrenia.

Some environmental risk factors include:

• Living in poverty
• Living with stress
• Prenatal exposure to viruses or pathogens
• Prenatal malnutrition
• History of abuse or neglect

Substance Use

Drugs do not independently cause undifferentiated schizophrenia, but some drugs have been linked to an increased risk of schizophrenia in those who are susceptible.

Schizophrenia is linked most closely with use of:

• Cannabis
• Cocaine
• LSD
• Amphetamines

Research has shown a link between excessive use of cannabis by adolescents and the subsequent development of schizophrenia.

Brain Chemistry

Dysfunctions of the neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine have been linked to undifferentiated schizophrenia.

More specifically, excessive dopamine activity is linked to hallucinations, agitation, and delusions, while abnormalities in norepinephrine are linked to negative and cognitive symptoms of schizophrenia.

Brain Physiology

Differences in brain structure and function are believed to play a part in undifferentiated schizophrenia.

For example:

• Differences in the volumes of specific components of the brain
• Differences in the way regions of the brain are connected and interact

These brain differences may begin before birth. Schizophrenia or other forms of psychosis may be triggered by changes to the brain during puberty in those who are susceptible due to genetics, environmental factors, or brain differences.

Treatment

Although undifferentiated schizophrenia is no longer a recognized category in the DSM-5, the way it was treated in the past is essentially the same as how schizophrenia is treated today.

Both then and now, the treatment is individually tailored based on the types, severity, and duration of symptoms a person has. Specifiers can further direct which treatments are the most useful and which are the least.

Available treatment options are outlined below.

Medication

Medication, particularly antipsychotics, is the most common treatment for undifferentiated schizophrenia. Antipsychotic medications can be taken in pill or liquid form, or by injection.

Some antipsychotics include:

• Zyprexa (olanzapine)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Geodon (ziprasidone)
• Abilify (aripiprazole)
• Invega (paliperidone)

Side effects of antipsychotics may include:

• Weight gain
• Dry mouth
• Restlessness
• Drowsiness 

Some people may be prescribed mood stabilizers such as:

• Lithobid (lithium)
• Depakote (divalproex sodium)
• Tegretol (carbamazepine)
• Lamictal (lamotrigine)

In some cases, people with undifferentiated schizophrenia may be prescribed antidepressants such as:

• Prozac (fluoxetine)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Celexa (citalopram)
• Lexapro (escitalopram)
• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)
• Cymbalta (duloxetine)
• Wellbutrin (bupropion)

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is a type of ongoing therapy that can be effective for treating many psychiatric conditions.

With CBT, people who have undifferentiated schizophrenia can learn to identify maladaptive thought patterns and learn how to challenge them, and change the thoughts and their accompanying behaviors.

Family Education and Support

These programs are geared towards the family members and close friends of people who have schizophrenia. They aim to help loved ones understand the condition, learn ways to support the person who has undifferentiated schizophrenia, and find support for themselves.

These programs can be done individually, as a family, or as a group with other families.

Coordinated Specialty Care

This type of treatment involves a team of specialists working together to provide help such as:

• Psychotherapy
• Medication management
• Case management
• Employment and education support
• Family education and support

It may be particularly helpful for people in an early stage of schizophrenia called first-episode psychosis.

Assertive Community Treatment (ACT)

ACT aims to reduce the number of hospitalizations for people with undifferentiated schizophrenia and to decrease the number of people without housing.

It involves:

• A multidisciplinary team, including a medication prescriber
• A shared caseload among team members
• Direct service provided by team members
• A high frequency of contact with the person who has schizophrenia
• A low ratio between staff and the people with schizophrenia
• Outreach to people with schizophrenia in the community

Social Skills Training

This treatment uses rehearsing or role-playing real-life situations to help a person with undifferentiated schizophrenia re-learn how to act and interact appropriately in social settings.

Supported Employment

This program helps people with undifferentiated schizophrenia enter the workforce with support, such as assistance with constructing resumes, preparing for job interviews, and connecting them with employers who hire and support people with mental illness.

Substance Use Treatment

Excessive substance use can make undifferentiated schizophrenia symptoms worse. Up to 50% of people with schizophrenia have substance use disorders. Substance use treatment is often a part of the treatment program for undifferentiated schizophrenia.

Coping

Schizophrenia is a life-long condition, so finding coping strategies is important.

Some helpful tips for those living with undifferentiated schizophrenia include:

• With the help of professionals, create and maintain a treatment plan.
• If prescribed medication, take it regularly as directed and do not stop without consulting a healthcare provider.
• Eat a healthy diet. Consulting with a dietitian may be helpful.
• Get plenty of exercise. Exercise is good for both physical and mental health.
• Manage and minimize stress with techniques such as relaxation, knowing and respecting your limits, and managing your emotions.
• Get plenty of sleep.
• Avoid substances like alcohol, drugs, and smoking.
• Speak with a healthcare provider about changing or adjusting medications if you are not noticing improvement or if your medications are causing bothersome side effects.
• Set goals and work towards them.

Finding Support

Living with undifferentiated schizophrenia is difficult to do alone. Having the support of others can make treatment and management of undifferentiated schizophrenia more effective, and make life with schizophrenia more enjoyable.

Some ways to find support include:

• Reaching out to trusted friends, family, and loved ones
• Joining activities or groups involving things you enjoy such as sports, volunteering, or hobbies
• Joining local clubs or organizations
• Finding a living environment that makes you feel safe and supports your needs, whether that means living alone, community or supportive living, living with friends or family, or something else
• Contacting support services in your area

A Word From Verywell

Undifferentiated schizophrenia can be hard to recognize and difficult to live with, but with proper support and treatment, it can be manageable.

If you are experiencing symptoms of undifferentiated schizophrenia, book an appointment to see your healthcare provider or a mental health professional to get a proper diagnosis, and find a treatment plan that works for you.